New Studies Examine Impact Of Medical Bills On Consumers

By Consumers for Quality Care, on August 20, 2018

Two new studies examine the impact of medical bills on consumers. Together, they provide a glimpse into what many consumers face after receiving medical care.

Contrary to the reason many individuals purchase health insurance, it does not a guarantee protection against high medical bills, USA Today reports. A Bankrate survey of 1,000 individuals found that close to half of those with insurance reported being shocked by the high prices of medical bills.

Close to half of adults who bought their own coverage, along with 43 percent of those with insurance through their employer, said they were surprised by the high cost of their most recent health-care bill in the last year, according to a survey from Bankrate.com. 

Consumers have experienced rising health costs in a number of ways, including increased cost sharing and high deductible plans. In 2017, the average family employer-sponsored health care plan cost $18,764. On average, consumers paid $5,714 of that cost.

These expenses only tell part of the story. Consumers are also coughing up money for copayments — the amount of money you pay each time you visit a doctor or buy a prescription drug.

A Kaiser Family Foundation report found that one in five individuals with employer-based coverage ended up receiving a hospital bill from an out-of-network provider.

A meaningful share of inpatient admissions result in the patient receiving a claim from an out-of-network provider, even when enrollees choose in-network facilities.

The report highlights that consumers do not always have the ability to avoid care from out-of-network providers.

[P]atients may not be in a position to select a network provider, for example in emergencies or urgent care situations. Other instances of out-of-network service use may be inadvertent, such as where an enrollee encounters an out-of-network provider (maybe an anesthesiologist) in the course of treatment at an in-network hospital or surgical center, or when their in-network provider refers them to an out-of-network provider for services such as laboratory testing or radiology.

The study examined the causes for hospitalization most likely to result in out-of-network bills, even when the hospital is in network. Anesthesia, pathology, emergency room, and mental health services are all more likely than other treatments to generate surprise bills.

A previous KFF study found that those with the least ability to pay surprise medical bills often are the ones who did not know their provider was out-of-network.

A 2016 KFF survey of medical debt found that among individuals who faced out-of-network bills they could not afford to pay, nearly 7 in 10 did not know the provider was out of their insurance network at the time they received care.

Moreover, the KFF study found that it is not reasonable to expect that consumers could avoid these charges.

In many instances, it is doubtful that enrollees could reasonably anticipate or control their use of out-of-network providers.

Both independently and together, these studies show the all too frequent negative impacts the convoluted insurance network system combined with increasing health care costs have on consumers as they try to access care.